新型冠状病毒肺炎患者的死亡危险因素分析

Analysis of risk factors for death in patients with coronavirus disease 2019

目的了解影响新型冠状病毒肺炎(COVID-19)患者死亡相关的危险因素。方法纳入2019年12月29日至2020年1月31日在武汉大学中南医院住院治疗的217例COVID-19患者。回顾性分析患者的一般情况、临床症状、基础疾病、实验室检查指标和临床转归等资料,根据患者预后,将患者分为死亡组与存活组,比较两组患者的临床表现和实验室检查结果。组间比较采用t检验和χ^2检验,采用二分类logistics回归模型对死亡相关危险因素进行逐步回归分析。结果217例COVID-19患者中,男124例,女93例;截至3月4日,死亡25例,存活192例,病死率为11.5%。89例(41.0%)患者有明确的华南海鲜市场暴露史或与COVID-19确诊患者的接触史。死亡患者中,男21例(84.0%),合并基础疾病者21例(84.0%),有3种以上临床症状者15例(60.0%),丙氨酸转氨酶或天冬氨酸转氨酶高于1.5倍正常值上限者14例(56.0%),肌酐>104μmol/L者13例(52.0%),降钙素原>0.05μg/L者18例(72.0%);存活患者中,上述指标分别为103例(53.6%)、95例(49.5%)、92例(47.9%)、23例(12.0%)、14例(7.3%)、47例(24.5%);两组比较差异均有统计学意义(χ^2=11.506、7.889、14.897、30.307、40.585、23.807,均P<0.01)。多因素分析发现,年龄≥65岁[比值比(odds ratio,OR)=5.968,95%可信区间(confidence interval,CI)1.991~17.888,P=0.001]、男性(OR=6.009,95%CI 2.504~14.422,P<0.01)、合并基础疾病(OR=7.152,95%CI 2.058~24.851,P=0.002)、出现3种以上临床症状(OR=7.944,95%CI 2.280~27.676,P=0.001)、丙氨酸转氨酶或天冬氨酸转氨酶高于1.5倍正常值上限(OR=9.552,95%CI 3.760~24.269,P<0.01)、肌酐>104μmol/L(OR=11.458,95%CI 4.289~30.613,P<0.01)、乳酸脱氢酶>243 U/L(OR=7.591,95%CI 1.683~34.249,P=0.008)和降钙素原>0.05μg/L(OR=12.410,95%CI 4.433~34.744,P<0.01)是影响COVID-19患者死亡的危险因素。结论高龄且合并基础疾病的男性COVID-19患者,如出现肝肾功能受损、乳酸脱氢酶升高和降钙素原升高,需高度警惕病情恶化的风险。

Objective To investigate the risk factors associated with death among patients with coronavirus disease 2019(COVID-19).Methods A total of 217 COVID-19 patients admitted to Zhongnan Hospital,Wuhan University from December 29,2019 to January 31,2020 were enrolled.The general conditions,clinical symptoms,comorbidities,laboratory test indicators and clinical outcomes of the COVID-19 patients were analyzed.According to prognosis,the COVID-19 patients were divided into the death group and the survival group,and the clinical manifestations and laboratory examination results of the two groups were compared by t test and chi-square test.The binary logistics regression model was used to analyze the risk factors related to death.Results Among the 217 COVID-19 cases,124 were males and 93 were females,as of March 4,2020,25 died and 192 survived,with the mortality of 11.5%.Eighty-nine patients(41.0%)had confirmed history of exposure to the Huanan seafood market or had close contact with another patient with confirmed COVID-19.Among the patients who died,21(84.0%)were male,21(84.0%)had comorbidities,15(60.0%)had more than three types of clinical symptoms,14(56.0%)had alaine aminotransferase or aspartate aminotransferase>1.5 upper limit of normal(ULN),13(52.0%)had creatinine(Cr)>104μmol/L,and 18(72.0%)had procalcitonin(PCT)>0.05μg/L,whereas the above indicators among the survival patients were 103(53.6%),95(49.5%),92(47.9%),23(12.0%),14(7.3%)and 47(24.5%),respectively.The differences of the above indicators between the two groups were all statistically significant(χ2=11.506,7.889,14.897,30.307,40.585 and 23.807,respectively,all P<0.01).The multivariate analysis results showed that age≥65 years old(odds ratio(OR)=5.968,95%confidence interval(CI)1.991-17.888,P=0.001),male(OR=6.009,95%CI 2.504-14.422,P<0.01),comorbidities(OR=7.152,95%CI 2.058-24.851,P=0.002),having more than three types of clinical symptoms(OR=7.944,95%CI 2.280-27.676,P=0.001),alanine aminotransferase or aspartate aminotransferase>1.5×ULN(OR=9.552,95%CI 3.760-24.269,P<0.01),Cr>104μmol/L(OR=11.458,95%CI 4.289-30.613,P<0.01),lactic acid dehydrogenase(LDH)>243 U/L(OR=7.591,95%CI 1.683-34.249,P=0.008)and PCT>0.05μg/L(OR=12.410,95%CI 4.433-34.744,P<0.01)were risk factors for death among COVID-19 infection patients.Conclusion For elderly male COVID-19 patients with comorbidities,impaired liver and kidney functions,elevated LDH and PCT are early warning signs for disease deterioration.